Are Clear Airway Apneas (CA) Bad?

Hi! This is my first post in this community but, won't be the last. I'm about 4 days in to my CPAP Therapy and have been doing some experimenting. I've read up alot on articles concerning OSA but, have a few doubts or questions. When I took the first sleep study, I came out with an RDI of 35.4, a sleep latency of 5 minutes, loud snoring with limited nasal flow, 5 OA's, 195 Hypopneas, 77 RERA's, Periodic Leg Movement of of 16.2, and what scared me most...oxygen desaturation of 90% for 50.9 minutes of my sleep time. During my second sleep study (with the CPAP), I came out with an RDI of 14.5, 17 OA's, 33 Hypopneas, and apparently no abnormal sleep behavior.

I was prescribed a Respironics System One RemStar Auto with A-Flex w/ Humidifier and a ComfortGel Full Face Mask. The prescribed pressure was APAP @ 5-20 cm/H2O. The doctor spoke highly of all the cool things the machine can do but, the funny thing was that when I got it from my provider, most of these features were off or locked. Most importantly, the machine was set to CPAP and not APAP; with a constant pressure of 15 cm/H2O.

A co-worker, (a 10 year CPAP Vet), says that when he started therapy, he immediately saw his world go from black & white to color. But, I haven't experienced that yet. I still feel sleepy as ever...yawning all the time and drained of all energy. The first night, I came out with an RDI of 4.29 (which is good) but, with 11 OA's, 7 CA's, 8 Hypopneas, and 6 RERA's. The 2nd night, I came out with an RDI of 11.65, with 7 OA's, 7 CA's, 6 Hypopneas, and 19 RERA's...so I decided to take matters into my own hands. I went ahead and went into the provider settings. I adjusted everything to my doctor's prescription and ended up with an RDI of 7.21 @ a max pressure of 15 cm/H2O, with 5 OA's, 10 CA's, 23 Hypopneas, 25 RERA's, and 16 Flow Limitation Events.

So then, I set the machine to CPAP with a pressure of 12 cm/H2O and ended with an RDI 11.41, 0 OA's, 0 Hypopneas, 2 RERA's but, with 8 CA's. Is that amount of CA's a bad thing or have I reached the optimum setting for me?

I haven't had an issue with leaks in my mask but, MAN does that mask hurt the bridge of my nose! I play with the staps but, to no avail. I wake up with the feeling that a crab has been pinching my nose the whole night. Th pain wakes me up constantly during the night, and then it takes forever for me to get back to sleep. So I end up sleep deprived with or without the machine. Any advice on any of these issues?

Thanks in advance,

First address the mask issue. If it is waking you up then you are not getting the sleep you need. A mask should "disappear" from your mind when you put it on. Go back to the DME and get it replaced. The manufacturers give THEM a 30 day return policy for you. Keep returning the mask until you find one for you. You wouldn't buy shoes that pinch in order to run a marathon, masks are the same.

When you change a setting do a small change and leave it for a week. One night doesn't tell you much.

CA's are bad for you but how many do you get per hour? Everyone gets a few when transitioning to sleep, that is the way the human brain works.

To answer your opening question. Any apnea, should not be considered good for you. Some may be worse then others. I suggest you go to the top of the page and click on the "light bulb" and read more information on apneas, even though you have already read a lot.
Nice of your Doctor to speak highly of your nice new machine. I have a few questions and/or comments about your post.
Please don;t be influenced by a co-workers experience in the starting your therapy. We all learn to take to CPAP therapy at different times and in different ways. SOme quite longer then others. You might want
In my opinion, with only 4 days under your belt, I think that you are very premature to start experimenting with the device Give yourself some time to adjust. The full face mask may not be the right interface for you either. It might be leaking and causing your AHI numbers to vary a bit. Most people try several different styles, both nasal , full face and pillows before they settle on the most comfort one.
Did you get a copy of your sleep study. If not , obtain it from them. Its a medical record and you are entitled to a copy. That way you should be able to determine what the pressure setting was that they found during your study that stopped nearly all of your apneas. Perhaps the 15 cmH2O that they (the DME) set it at, was "that" magic number. It appears that it was, especially if you got the same number after the third night when you put the machine back to APAP and got a reading of 15. ..THe setting as prescribed by your MD is kinda generic. 5-20 is the full range of the machine. Perhaps the MD wanted this setting in APAP to see how you would adjust to the therapy, verify the sleep studys findings and make a recommendation later during a follow-up.
I also suggest that you find some software and start tracking (but not changing!) your therapy.

It takes a few days for the silicone shield on a new Comfortgel cushion to 'break in'.
I have to use a small Band-Aid on my nose for a couple of days with a new one.
After that, I hardly feel a thing.
I also like my Full Life mask--no forehead cushion, and the accordion sides make the fit really soft.

Are you waking up during the night very much?
If you are some of those clear airway events could be sleep stage transition or sleep onset.
Which software are you using? Do you seen any clustering of those clear airway events or are they spread out rather evenly throughout the night?
Could you post an image of one of your detailed reports that you are concerned about?

When commenting about the total number of whatever kind of event...please include the hourly index for those events. If you tell me you had 15 events of some sort during the night that really doesn't tell me much without knowing how many hours of sleep goes along with it. Also when mentioning your RDI..can you break that down for us. I assume you are factoring in your RERAs and adding them to your AHI. If so, please clarify how much is apnea related and how much is RERA related.

8 clear airway events over 8 hours is nothing to worry about..that's one an hour.
Some might even be sleep onset and those wouldn't even be counted in a sleep study.